scholarly journals 1153. National Trend of Urinary Catheter Device Utilization by Hospital Type, National Healthcare Safety Network (2015–2019)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S411-S412
Author(s):  
Minn M Soe
Keyword(s):  
Acute Care ◽  
Negative Binomial ◽  
Urinary Catheter ◽  
Inpatient Rehabilitation ◽  
Acute Care Hospitals ◽  
Equation Modeling ◽  
Quality Reporting ◽  
Factors Associated ◽  
National Healthcare ◽  
National Healthcare Safety Network

Abstract Background Reducing unnecessary urinary catheter use and optimizing insertion techniques and catheter maintenance and care practices are the most important urinary tract infection (CAUTI) prevention strategies. To monitor device use (DU) as quality improvement activity, the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) developed the risk adjusted, standardized urinary catheter device utilization ratio in 2015. This study aims to assess national trends of DU from the baseline year 2015 through 2019. Methods For our trend analysis, we analyzed DU data (catheter days per 100 inpatient-days) that acute care hospitals (ACHs), long-term acute care hospitals (LTACHs), inpatient rehabilitation facilities (IRFs), and critical access hospitals (CAHs) reported to NHSN from 2015Q1 through 2019Q1. The ward and intensive care unit patient care locations included in our analysis are those that ACHs, LTACHs, IRFs and CAHs are required to report to CMS to comply with CMS Inpatient Quality Reporting program requirements. We regressed DU by quarterly period using generalized estimating equation modeling with the negative-binomial distribution, after adjusting for factors associated with corresponding SUR models of 2015 baseline and accounting for autocorrelation of error terms within a location. For graphic display, we also computed quarterly DU using marginal predictive models. Results The DU decreased over time (P ≤ 0.05, average percent change per quarter (%change): −0.54 [95% CI: −0.54, −0.53]) among ACHs (Table 1, Figure 1), and −0.54 [95% CI: −0.58, −0.49] among LTACHs (Table 1, Figure 2). Among IRFs, quarterly DU in 2015Q2–2016Q3 were similar relative to 2015Q1, but decreased from 2016Q4 onward (P ≤ 0.05, % change: −0.51 [95% CI: −0.61, −0.40]) (Table 1, Figure 3). Among CAHs, quarterly DU in 2015Q2–2016Q4 were similar relative to 2015Q1, but decreased from 2017Q1 onward (P ≤ 0.05, % change: −0.22 [95% CI: −0.39, −0.04]) (Table 1, Figure 4). Conclusion There was a statistically significant decrease in National DU of urinary catheter during 2015–2019 across NHSN, although the magnitude of change per quarter was not large. Further research is needed to explore causal factors associated with such reduction. Disclosures All authors: No reported disclosures.

scholarly journals Antibiotic Multidrug Resistance of Escherichia coli Causing Device- and Procedure-related Infections in the United States Reported to the National Healthcare Safety Network, 2013–2017

2020 ◽  
Author(s):  
Athena P Kourtis ◽  
Edward A Sheriff ◽  
Lindsey M Weiner-Lastinger ◽  
Kim Elmore ◽  
Leigh Ellyn Preston ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Multidrug Resistance ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
The United States ◽  
E Coli ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Hospital Referral

Abstract Background Escherichia coli is one of the most common causes of healthcare-associated infections (HAIs); multidrug resistance reduces available options for antibiotic treatment. We examined factors associated with the spread of multidrug-resistant E. coli phenotypes responsible for device- and procedure-related HAIs from acute care hospitals, long-term acute care hospitals, and inpatient rehabilitation facilities, using isolate and antimicrobial susceptibility data reported to the National Healthcare Safety Network during 2013–2017. Methods We used multivariable logistic regression to examine associations between co-resistant phenotypes, patient and healthcare facility characteristics, and time. We also examined the geographic distribution of co-resistant phenotypes each year by state and by hospital referral region to identify hot spots. Results A total of 96 672 E. coli isolates were included. Patient median age was 62 years, and 60% were female; more than half (54%) were reported from catheter-associated urinary tract infections. From 2013 to 2017, 35% of the isolates were nonsusceptible to fluoroquinolones (FQs), 17% to extended-spectrum cephalosporins (ESCs), and 13% to both ESCs and FQs. The proportion of isolates co-resistant to ESCs and FQs was higher in 2017 (14%) than in 2013 (11%) (P < .0001); overall prevalence and increases were heterogeneously distributed across healthcare referral regions. Co-resistance to FQs and ESCs was independently associated with male sex, central line–associated bloodstream infections, long-term acute care hospitals, and the 2016–2017 (vs 2013–2014) reporting period. Conclusions Multidrug resistance among E. coli causing device- and procedure-related HAIs has increased in the United States. FQ and ESC co-resistant strains appear to be spreading heterogeneously across hospital referral regions.

scholarly journals Antibiotic Stewardship Programs in U.S. Acute Care Hospitals: Findings From the 2014 National Healthcare Safety Network Annual Hospital Survey

2016 ◽  
Vol 63 (4) ◽  
pp. 443-449 ◽  
Author(s):  
Lori A. Pollack ◽  
Katharina L. van Santen ◽  
Lindsey M. Weiner ◽  
Margaret A. Dudeck ◽  
Jonathan R. Edwards ◽  
...  
Keyword(s):  
Acute Care ◽  
Antibiotic Stewardship ◽  
Acute Care Hospitals ◽  
National Healthcare ◽  
National Healthcare Safety Network

scholarly journals Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network, 2015–2017

2019 ◽  
Vol 41 (1) ◽  
pp. 1-18 ◽  
Author(s):  
Lindsey M. Weiner-Lastinger ◽  
Sheila Abner ◽  
Jonathan R. Edwards ◽  
Alexander J. Kallen ◽  
Maria Karlsson ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Healthcare Associated Infections ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Tract Infections ◽  
Healthcare Associated ◽  
Location Type

AbstractObjective:Describe common pathogens and antimicrobial resistance patterns for healthcare-associated infections (HAIs) that occurred during 2015–2017 and were reported to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN).Methods:Data from central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), and surgical site infections (SSIs) were reported from acute-care hospitals, long-term acute-care hospitals, and inpatient rehabilitation facilities. This analysis included device-associated HAIs reported from adult location types, and SSIs among patients ≥18 years old. Percentages of pathogens with nonsusceptibility (%NS) to selected antimicrobials were calculated for each HAI type, location type, surgical category, and surgical wound closure technique.Results:Overall, 5,626 facilities performed adult HAI surveillance during this period, most of which were general acute-care hospitals with <200 beds. Escherichia coli (18%), Staphylococcus aureus (12%), and Klebsiella spp (9%) were the 3 most frequently reported pathogens. Pathogens varied by HAI and location type, with oncology units having a distinct pathogen distribution compared to other settings. The %NS for most pathogens was significantly higher among device-associated HAIs than SSIs. In addition, pathogens from long-term acute-care hospitals had a significantly higher %NS than those from general hospital wards.Conclusions:This report provides an updated national summary of pathogen distributions and antimicrobial resistance among select HAIs and pathogens, stratified by several factors. These data underscore the importance of tracking antimicrobial resistance, particularly in vulnerable populations such as long-term acute-care hospitals and intensive care units.

scholarly journals Uptake of Antibiotic Stewardship Programs in US Acute Care Hospitals: Findings From the 2015 National Healthcare Safety Network Annual Hospital Survey

2017 ◽  
Vol 65 (10) ◽  
pp. 1748-1750 ◽  
Author(s):  
Erin N O’Leary ◽  
Katharina L van Santen ◽  
Amy K Webb ◽  
Daniel A Pollock ◽  
Jonathan R Edwards ◽  
...  
Keyword(s):  
Acute Care ◽  
Antibiotic Stewardship ◽  
Acute Care Hospitals ◽  
National Healthcare ◽  
National Healthcare Safety Network

Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infection: Results from a Field Test of a New National Healthcare Safety Network Definition

2013 ◽  
Vol 34 (8) ◽  
pp. 769-776 ◽  
Author(s):  
Isaac See ◽  
Martha Iwamoto ◽  
Kathy Allen-Bridson ◽  
Teresa Horan ◽  
Shelley S. Magill ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Acute Care ◽  
Field Test ◽  
Acute Care Hospitals ◽  
Field Testing ◽  
Hospital Staff ◽  
Mucosal Barrier ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Mucosal Barrier Injury

Objective.To assess challenges to implementation of a new National Healthcare Safety Network (NHSN) surveillance definition, mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI).Design.Multicenter field test.Setting.Selected locations of acute care hospitals participating in NHSN central line-associated bloodstream infection (CLABSI) surveillance.Methods.Hospital staff augmented their CLABSI surveillance for 2 months to incorporate MBI-LCBI: a primary bloodstream infection due to a selected group of organisms in patients with either neutropenia or an allogeneic hematopoietic stem cell transplant with gastrointestinal graft-versus-host disease or diarrhea. Centers for Disease Control and Prevention (CDC) staff reviewed submitted data to verify whether CLABSIs met MBI-LCBI criteria and summarized the descriptive epidemiology of cases reported.Results.Eight cancer, 2 pediatric, and 28 general acute care hospitals including 193 inpatient units (49% oncology/bone marrow transplant [BMT], 21% adult ward, 20% adult critical care, 6% pediatric, 4% step-down) conducted field testing. Among 906 positive blood cultures reviewed, 282 CLABSIs were identified. Of the 103 CLABSIs that also met MBI-LCBI criteria, 100 (97%) were reported from oncology/BMT locations. Agreement between hospital staff and CDC classification of reported CLABSIs as meeting the MBI-LCBI definition was high (90%; k= 0.82). Most MBI-LCBIs (91%) occurred in patients meeting neutropenia criteria. Some hospitals indicated that their laboratories' methods of reporting cell counts prevented application of neutropenia criteria; revised neutropenia criteria were created using data from field testing.Conclusions.Hospital staff applied the MBI-LCBI definition accurately. Field testing informed modifications for the January 2013 implementation of MBI-LCBI in the NHSN.

scholarly journals Antimicrobial-Resistant Pathogens Associated With Healthcare-Associated Infections: Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011–2014

2016 ◽  
Vol 37 (11) ◽  
pp. 1288-1301 ◽  
Author(s):  
Lindsey M. Weiner ◽  
Amy K. Webb ◽  
Brandi Limbago ◽  
Margaret A. Dudeck ◽  
Jean Patel ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Disease Control ◽  
Acute Care ◽  
Surgical Site Infections ◽  
Acute Care Hospitals ◽  
Healthcare Associated Infections ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Resistance Patterns ◽  
Healthcare Associated

OBJECTIVETo describe antimicrobial resistance patterns for healthcare-associated infections (HAIs) that occurred in 2011–2014 and were reported to the Centers for Disease Control and Prevention’s National Healthcare Safety Network.METHODSData from central line–associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonias, and surgical site infections were analyzed. These HAIs were reported from acute care hospitals, long-term acute care hospitals, and inpatient rehabilitation facilities. Pooled mean proportions of pathogens that tested resistant (or nonsusceptible) to selected antimicrobials were calculated by year and HAI type.RESULTSOverall, 4,515 hospitals reported that at least 1 HAI occurred in 2011–2014. There were 408,151 pathogens from 365,490 HAIs reported to the National Healthcare Safety Network, most of which were reported from acute care hospitals with greater than 200 beds. Fifteen pathogen groups accounted for 87% of reported pathogens; the most common included Escherichia coli (15%), Staphylococcus aureus (12%), Klebsiella species (8%), and coagulase-negative staphylococci (8%). In general, the proportion of isolates with common resistance phenotypes was higher among device-associated HAIs compared with surgical site infections. Although the percent resistance for most phenotypes was similar to earlier reports, an increase in the magnitude of the resistance percentages among E. coli pathogens was noted, especially related to fluoroquinolone resistance.CONCLUSIONThis report represents a national summary of antimicrobial resistance among select HAIs and phenotypes. The distribution of frequent pathogens and some resistance patterns appear to have changed from 2009–2010, highlighting the need for continual, careful monitoring of these data across the spectrum of HAI types.Infect Control Hosp Epidemiol 2016;1–14

scholarly journals Antifungal Susceptibility Testing Practices at Acute Care Hospitals Enrolled in the National Healthcare Safety Network, United States, 2011–2015

2017 ◽  
Vol 4 (4) ◽  
Author(s):  
Snigdha Vallabhaneni ◽  
Mathew Sapiano ◽  
Lindsey M Weiner ◽  
Shawn R Lockhart ◽  
Shelley Magill
Keyword(s):  
United States ◽  
Acute Care ◽  
Susceptibility Testing ◽  
Medical Center ◽  
Antifungal Susceptibility ◽  
Acute Care Hospitals ◽  
Antifungal Susceptibility Testing ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Testing Practices

Abstract We assessed availability of antifungal susceptibility testing (AFST) at nearly 4000 acute care hospitals enrolled in the National Healthcare Safety Network. In 2015, 95% offered any AFST, 28% offered AFST at their own laboratory or at an affiliated medical center, and 33% offered reflexive AFST. Availability of AFST improved from 2011 to 2015, but substantial gaps exist in the availability of AFST.

The occurrence and timing of delirium in acute care hospitalizations in the last year of life: A population-based retrospective cohort study

2020 ◽  
Vol 34 (8) ◽  
pp. 1067-1077
Author(s):  
Colleen Webber ◽  
Christine L Watt ◽  
Shirley H Bush ◽  
Peter G Lawlor ◽  
Robert Talarico ◽  
...  
Keyword(s):  
Cohort Study ◽  
Confidence Interval ◽  
Acute Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Prevalence Ratio ◽  
Acute Care Hospitals ◽  
Population Based ◽  
Care Hospital ◽  
Factors Associated

Background: Delirium is a distressing neurocognitive disorder that is common among terminally ill individuals, although few studies have described its occurrence in the acute care setting among this population. Aim: To describe the prevalence of delirium in patients admitted to acute care hospitals in Ontario, Canada, in their last year of life and identify factors associated with delirium. Design: Population-based retrospective cohort study using linked health administrative data. Delirium was identified through diagnosis codes on hospitalization records. Setting/participants: Ontario decedents (1 January 2014 to 31 December 2016) admitted to an acute care hospital in their last year of life, excluding individuals age of <18 years or >105 years at admission, those not eligible for the provincial health insurance plan between their hospitalization and death dates, and non-Ontario residents. Results: Delirium was recorded as a diagnosis in 8.2% of hospitalizations. The frequency of delirium-related hospitalizations increased as death approached. Delirium prevalence was higher in patients with dementia (prevalence ratio: 1.43; 95% confidence interval: 1.36–1.50), frailty (prevalence ratio: 1.67; 95% confidence interval: 1.56–1.80), or organ failure–related cause of death (prevalence ratio: 1.23; 95% confidence interval: 1.16–1.31) and an opioid prescription (prevalence ratio: 1.17; 95% confidence interval: 1.12–1.21). Prevalence also varied by age, sex, chronic conditions, antipsychotic use, receipt of long-term care or home care, and hospitalization characteristics. Conclusion: This study described the occurrence and timing of delirium in acute care hospitals in the last year of life and identified factors associated with delirium. These findings can be used to support delirium prevention and early detection in the hospital setting.

Sharps Injuries among Employees of Acute Care Hospitals in Massachusetts, 2002–2007

2011 ◽  
Vol 32 (6) ◽  
pp. 538-544 ◽  
Author(s):  
Angela K. Laramie ◽  
Vivian C. Pun ◽  
Shona C. Fang ◽  
David Kriebel ◽  
Letitia Davis
Keyword(s):  
Acute Care ◽  
Surveillance System ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Acute Care Hospitals ◽  
Injury Surveillance System ◽  
Hospital Size ◽  
Sharps Injury ◽  
The Impact ◽  
Sharps Injuries

Objective.Sharps with engineered sharps injury protections (SESIPs) have been found to reduce risk of sharps injuries (Sis). We examined trends in SI rates among employees of acute care hospitals in Massachusetts, including the impact of SESIPs on SI trends during 2002-2007.Design.Prospective surveillance.Setting.Seventy-six acute care hospitals licensed by the Massachusetts Department of Public Health.Participants.Employees of acute care hospitals who reported Sis to their employers.Methods.Data on Sis in acute care hospitals collected by the Massachusetts Sharps Injury Surveillance System were used to examine trends in SI rates over time by occupation, hospital size, and device. Negative binomial regression was used to assess trends.Results.During 2002-2007, 16,158 Sis among employees of 76 acute care hospitals were reported to the surveillance system. The annual SI rate decreased by 22%, with an annual decline of 4.7% (P< .001). Rates declined significantly among nurses (—7.2% per year;P< .001) but not among physicians (—0.9% per year;P= .553). SI rates associated with winged steel needles and hypodermic needles and syringes also declined significantly as the proportion of injuries involving devices with sharps injury prevention features increased during the same time period.Conclusion.SI rates involving devices for which SESIPs are widely available and appear to be increasingly used have declined. The continued use of devices lacking SI protections for which SESIPs are available needs to be addressed. The extent to which injuries involving SESIPs are due to flaws in design or lack of experience and training must be examined.

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